| NPI | 1942540877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q5148) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q5148) |
| Enumeration Date | 2013-03-01 |
| Last Update Date | 2017-06-27 |